1
|
Effect of Dietary Salt Intake on Risk of Gastric Cancer: A Systematic Review and Meta-Analysis of Case-Control Studies. Nutrients 2022; 14:nu14204260. [PMID: 36296944 PMCID: PMC9609108 DOI: 10.3390/nu14204260] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 02/07/2023] Open
Abstract
Aim: The effect of dietary salt intake on the risk of gastric cancer is not clear. A meta-analysis was performed to estimate the association between dietary salt intake and the risk of gastric cancer. Methods: Three major databases were searched to retrieve case-control studies published in English before 1 July 2022. Random effects model analysis was used to obtain the pooled odds ratios (ORs) and 95% confidence intervals (CIs) of the association between dietary salt intake and risk of gastric cancer. Subgroup analyses were used to identify possible sources of heterogeneity. Results: Thirty-eight case-control studies were included in this meta-analysis (total population: n = 37,225). The pooled ORs showed a significantly positive association between high salt intake and gastric cancer compared with low salt intake (OR = 1.55, 95% CI (1.45, 1.64); p < 0.001). In subgroup meta-analysis for geographic region, estimation method for dietary salt intake and the source of controls, this association was not changed. Conclusion: Higher dietary salt intake increased the risk of gastric cancer. This study has implications for the prevention of gastric cancer.
Collapse
|
2
|
Thapa S, Fischbach LA, Delongchamp R, Faramawi MF, Orloff M. The Association between Salt and Potential Mediators of the Gastric Precancerous Process. Cancers (Basel) 2019; 11:cancers11040535. [PMID: 30991669 PMCID: PMC6520685 DOI: 10.3390/cancers11040535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/28/2019] [Accepted: 04/04/2019] [Indexed: 12/14/2022] Open
Abstract
Background: The process by which salt affects the gastric precancerous process has not been adequately studied in humans. Methods: We investigated the effects of salt on gastric inflammation, epithelial damage, the density of Helicobacter pylori infection, and gastric epithelial cell proliferation, all of which may be mediators between salt and gastric precancerous/cancerous lesions. These potential mediators were measured using gastric biopsies as: (a) the density of polymorphonuclear and mononuclear cells (gastric inflammation), (b) mucus depletion (gastric epithelial damage), and (c) the severity of H. pylori infection. Salt intake was measured with spot urine samples (using urinary sodium/creatinine ratios), self-reported frequency of adding salt to food, and as total added salt. Results: The average sodium/creatinine ratio (at baseline and post-treatment at five months) was associated with increased epithelial damage over the 12-year follow-up period among those with a greater severity of chronic inflammation and among those with continued H. pylori infection after treatment at five months. This association was stronger when both severe gastric inflammation and H. pylori infection were present at five months (ß: 1.112, 95% CI: 0.377, 1.848). Conclusion: In humans, salt was associated with an increase in epithelial damage in stomachs with more severe previous H. pylori-induced chronic inflammation.
Collapse
Affiliation(s)
- Susan Thapa
- Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Lori A Fischbach
- Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Robert Delongchamp
- Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Mohammed F Faramawi
- Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Mohammed Orloff
- Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| |
Collapse
|
3
|
Thapa S, Fischbach LA, Delongchamp R, Faramawi MF, Orloff M. Association between Dietary Salt Intake and Progression in the Gastric Precancerous Process. Cancers (Basel) 2019; 11:cancers11040467. [PMID: 30987215 PMCID: PMC6520970 DOI: 10.3390/cancers11040467] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/21/2019] [Accepted: 03/27/2019] [Indexed: 02/07/2023] Open
Abstract
Gastric cancer is the third leading cause of cancer mortality worldwide. Studies investigating the effect of salt on gastric cancer have mainly used self-reported measures, which are not as accurate as sodium/creatinine ratios because individuals may not know the amount of salt in their food. Using data from a prospective cohort study, we investigated the effect of salt intake on progression to gastric precancerous lesions. Salt intake was estimated by urinary sodium/creatinine ratios, self-reported frequencies of adding salt to food, and total added table salt. We repeated the analyses among groups with and without Helicobacter pylori infection. We did not observe a positive association between salt intake, measured by urinary sodium/creatinine ratio, and overall progression in the gastric precancerous process (adjusted risk ratio (RR): 0.94; 95% confidence interval (CI) 0.76-1.15). We did observe an association between salt intake and increased risk for progression to dysplasia or gastric cancer overall (adjusted risk ratio (RR): 1.32; 95% confidence interval (CI): 0.96-1.81), especially among those who continued to have H. pylori infection at the five-month follow-up (adjusted RR: 1.53; 95% CI: 1.12-2.09), and among those who had persistent H. pylori infection over 12 years (adjusted RR: 1.49; 95% CI: 1.09-2.05). Salt intake may increase the risk of gastric dysplasia or gastric cancer in individuals with H. pylori infection.
Collapse
Affiliation(s)
- Susan Thapa
- Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Lori A Fischbach
- Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Robert Delongchamp
- Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Mohammed F Faramawi
- Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Mohammed Orloff
- Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| |
Collapse
|
4
|
Zarei S, Eggert J, Franqui-Dominguez L, Carl Y, Boria F, Stukova M, Avila A, Rubi C, Chinea A. Comprehensive review of neuromyelitis optica and clinical characteristics of neuromyelitis optica patients in Puerto Rico. Surg Neurol Int 2018; 9:242. [PMID: 30603227 PMCID: PMC6293609 DOI: 10.4103/sni.sni_224_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022] Open
Abstract
Neuromyelitis optica (NMO) is an immune-mediated inflammatory disorder of the central nervous system. It is characterized by concurrent inflammation and demyelination of the optic nerve (optic neuritis [ON]) and the spinal cord (myelitis). Multiple studies show variations in prevalence, clinical, and demographic features of NMO among different populations. In addition, ethnicity and race are known as important factors on disease phenotype and clinical outcomes. There are little data on information about NMO patients in underserved groups, including Puerto Rico (PR). In this research, we will provide a comprehensive overview of all aspects of NMO, including epidemiology, environmental risk factors, genetic factors, molecular mechanism, symptoms, comorbidities and clinical differentiation, diagnosis, treatment, its management, and prognosis. We will also evaluate the demographic features and clinical phenotype of NMO patients in PR. This will provide a better understanding of NMO and establish a basis of knowledge that can be used to improve care. Furthermore, this type of population-based study can distinguish the clinical features variation among NMO patients and will provide insight into the potential mechanisms that cause these variations.
Collapse
Affiliation(s)
- Sara Zarei
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - James Eggert
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | - Yonatan Carl
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Fernando Boria
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Marina Stukova
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | - Cristina Rubi
- Caribbean Neurological Center, Guaynabo, Puerto Rico, USA
| | - Angel Chinea
- Caribbean Neurological Center, Guaynabo, Puerto Rico, USA
| |
Collapse
|
5
|
Development of a multi-physical finite element-based model that predicts water and salt transfers, proteolysis and water activity during the salting and post-salting stages of the dry-cured ham process. J FOOD ENG 2018. [DOI: 10.1016/j.jfoodeng.2017.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
6
|
Lin SH, Li YH, Leung K, Huang CY, Wang XR. Salt processed food and gastric cancer in a Chinese population. Asian Pac J Cancer Prev 2015; 15:5293-8. [PMID: 25040991 DOI: 10.7314/apjcp.2014.15.13.5293] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
To investigate the association between salt processed food and gastric cancer, a hospital based case-control study was conducted in a high risk area of China. One hundred and seven newly diagnosed cases with histological confirmation of gastric cancer and 209 controls were recruited. Information on dietary intake was collected with a validated food frequency questionnaire. Unconditional logistic regression was applied to estimate the odds ratios with adjustment for other potential confounders. Comparing the high intake group with never consumption of salt processed foods, salted meat, pickled vegetables and preserved vegetables were significantly associated with increased risk of gastric cancer. Meanwhile, salt taste preference in diet showed a dose-response relationship with gastric cancer. Our results suggest that consumption of salted meat, pickled and preserved vegetables, are positively associated with gastric cancer. Reduction of salt and salt processed food in diets might be one practical measure to preventing gastric cancer.
Collapse
Affiliation(s)
- Si-Hao Lin
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong E-mail :
| | | | | | | | | |
Collapse
|
7
|
Zhu H, Yang X, Zhang C, Zhu C, Tao G, Zhao L, Tang S, Shu Z, Cai J, Dai S, Qin Q, Xu L, Cheng H, Sun X. Red and processed meat intake is associated with higher gastric cancer risk: a meta-analysis of epidemiological observational studies. PLoS One 2013; 8:e70955. [PMID: 23967140 PMCID: PMC3743884 DOI: 10.1371/journal.pone.0070955] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/26/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Red and processed meat was concluded as a limited-suggestive risk factor of gastric cancer by the World Cancer Research Fund. However, recent epidemiological studies have yielded inconclusive results. METHODS We searched Medline, EMBASE, and the Cochrane Library from their inception to April 2013 for both cohort and case-control studies which assessed the association between red and/or processed meat intake and gastric cancer risk. Study-specific relative risk estimates were polled by random-effect or fixed-effect models. RESULTS Twelve cohort and thirty case-control studies were included in the meta-analysis. Significant associations were found between both red (RR: 1.45, 95% CI: 1.22-1.73) and processed (RR: 1.45, 95% CI: 1.26-1.65) meat intake and gastric cancer risk generally. Positive findings were also existed in the items of beef (RR: 1.28, 95% CI: 1.04-1.57), bacon (RR: 1.37, 95% CI: 1.17-1.61), ham (RR: 1.44, 95% CI: 1.00-2.06), and sausage (RR: 1.33, 95% CI: 1.16-1.52). When conducted by study design, the association was significant in case-control studies (RR: 1.63, 95% CI: 1.33-1.99) but not in cohort studies (RR: 1.02, 95% CI: 0.90-1.17) for red meat. Increased relative risks were seen in high-quality, adenocarcinoma, cardia and European-population studies for red meat. And most subgroup analysis confirmed the significant association between processed meat intake and gastric cancer risk. CONCLUSIONS Our findings indicate that consumption of red and/or processed meat contributes to increased gastric cancer risk. However, further investigation is needed to confirm the association, especially for red meat.
Collapse
Affiliation(s)
- Hongcheng Zhu
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xi Yang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chi Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chen Zhu
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory for Modern Toxicology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Guangzhou Tao
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China
| | - Lianjun Zhao
- The Comprehensive Cancer Center, Nanjing Drum Tower Hospital and Clinical College of Nanjing Medical University, Nanjing, China
| | - Shaowen Tang
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory for Modern Toxicology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zheng Shu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Jing Cai
- Tumor Institute, Nantong Tumor Hospital, Nantong, China
| | - Shengbin Dai
- Department of Oncology, Taizhou People's Hospital, Taizhou, China
| | - Qin Qin
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liping Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongyan Cheng
- Department of Synthetic Internal Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinchen Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
8
|
De Stefani E, Boffetta P, Ronco AL, Deneo-Pellegrini H, Correa P, Acosta G, Mendilaharsu M, Luaces ME, Silva C. Processed meat consumption and risk of cancer: a multisite case-control study in Uruguay. Br J Cancer 2012; 107:1584-8. [PMID: 23011480 PMCID: PMC3493769 DOI: 10.1038/bjc.2012.433] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/15/2012] [Accepted: 08/20/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The role of processed meat in the aetiology of several cancers was explored in detail. METHODS In the time period 1996-2004, a multisite case-control study was conducted in Montevideo, Uruguay. The study included 6 060 participants (3 528 cases and 2 532 controls) corresponding to cancers of the oral cavity, pharynx, oesophagus, stomach, colon, rectum, larynx, lung, female breast, prostate, urinary bladder, and kidney (renal cell carcinoma only). RESULTS The highest odds ratios (ORs) were positively associated with cancers of the colon, rectum, stomach, oesophagus, and lung. With the exception of renal cell carcinoma, the remaining cancer sites were significantly associated with elevated risks for processed meat consumption. Furthermore, mortadella, salami, hot dog, ham, and salted meat were strongly associated with risk of several cancer sites. CONCLUSION It could be concluded that processed meat intake could be a powerful multiorgan carcinogen.
Collapse
Affiliation(s)
- E De Stefani
- Epidemiology Group, Department of Pathology, School of Medicine, University of the Republic, Montevideo, Uruguay.
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Perri F, Terracciano F, Gentile M, Merla A, Scimeca D, Zullo A. Role of interleukin polymorphisms in gastric cancer: "Pros and cons". World J Gastrointest Oncol 2010; 2:265-71. [PMID: 21160639 PMCID: PMC2999189 DOI: 10.4251/wjgo.v2.i6.265] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 12/08/2009] [Accepted: 12/15/2009] [Indexed: 02/05/2023] Open
Abstract
Helicobacter pylori (H. pylori) infection is the leading cause of gastric cancer worldwide. Infection with this bacterium causes a chronic active immune response that persists for the life of the host. The combination of bacterial factors, environmental insults, and the host immune response drives the initiation and progression of mucosal atrophy, metaplasia, and dysplasia toward GC. Among the host factors, IL-1 gene cluster polymorphisms (IL-1B encoding IL-1β and IL-1RN encoding IL-1ra, its naturally occurring receptor antagonist) play a decisive role in modulating the risk of developing hypochlorhydria, gastric atrophy and GC in the presence of H. pylori infection. In particular, one single nucleotide polymorphism in the IL-1B promoter (IL-1B-511C⁄T), and the short allele of a 86-bp variable number of tandem repeats polymorphism in the IL-1RN second intron (IL-1RN*2) are associated with an increased risk for GC. However this hypothesis is still to be fully confirmed. This review focuses on the divergent results obtained by several epidemiological and functional in vitro and in vivo studies and show that IL-1 genotyping has still no role in the clinical management of patients with H. pylori infection.
Collapse
Affiliation(s)
- Francesco Perri
- Francesco Perri, Fulvia Terracciano, Marco Gentile, Antonio Merla, Daniela Scimeca, Department of Gastroenterology and Digestive Endoscopy, "Casa Sollievo della Sofferenza" Hospital, IRCCS, 71013 San Giovanni Rotondo (FG), Italy
| | | | | | | | | | | |
Collapse
|
10
|
Ortiz AP, Soto-Salgado M, Calo WA, Tortolero-Luna G, Pérez CM, Romero CJ, Pérez J, Figueroa-Vallés N, Suárez E. Incidence and mortality rates of selected infection-related cancers in Puerto Rico and in the United States. Infect Agent Cancer 2010; 5:10. [PMID: 20470399 PMCID: PMC2891681 DOI: 10.1186/1750-9378-5-10] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 05/14/2010] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In 2002, 17.8% of the global cancer burden was attributable to infections. This study assessed the age-standardized incidence and mortality rates of stomach, liver, and cervical cancer in Puerto Rico (PR) for the period 1992-2003 and compared them to those of Hispanics (USH), non-Hispanic Whites (NHW), and non-Hispanic Blacks (NHB) in the United States (US). METHODS Age-standardized rates [ASR(World)] were calculated based on cancer incidence and mortality data from the PR Cancer Central Registry and SEER, using the direct method and the world population as the standard. Annual percent changes (APC) were calculated using the Poisson regression model from 1992-2003. RESULTS The incidence and mortality rates from stomach, liver and cervical cancer were lower in NHW than PR; with the exception of mortality from cervical cancer which was similar in both populations. Meanwhile, the incidence rates of stomach, liver and cervical cancers were similar between NHB and PR; except for NHB women who had a lower incidence rate of liver cancer than women in PR. NHB had a lower mortality from liver cancer than persons in PR, and similar mortality from stomach cancer. CONCLUSIONS The burden of liver, stomach, and cervical cancer in PR compares to that of USH and NHB and continues to be a public health priority. Public health efforts are necessary to further decrease the burden of cancers associated to infections in these groups, the largest minority population groups in the US. Future studies need to identify factors that may prevent infections with cancer-related agents in these populations. Strategies to increase the use of preventive strategies, such as vaccination and screening, among minority populations should also be developed.
Collapse
Affiliation(s)
- Ana P Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Graduate School of Public Health, Department of Biostatistics and Epidemiology, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Marievelisse Soto-Salgado
- Medical Sciences Campus, Puerto Rico Cancer Center, University of Puerto Rico, San Juan, Puerto Rico
| | - William A Calo
- Medical Sciences Campus, Puerto Rico Cancer Center, University of Puerto Rico, San Juan, Puerto Rico
| | - Guillermo Tortolero-Luna
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Cynthia M Pérez
- Graduate School of Public Health, Department of Biostatistics and Epidemiology, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Carlos J Romero
- School of Medicine, Gastroenterology Research Unit, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Javier Pérez
- Puerto Rico Central Cancer Registry, San Juan, Puerto Rico
| | - Nayda Figueroa-Vallés
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Puerto Rico Central Cancer Registry, San Juan, Puerto Rico
| | - Erick Suárez
- Graduate School of Public Health, Department of Biostatistics and Epidemiology, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| |
Collapse
|
11
|
Kim J, Park S, Nam BH. Gastric cancer and salt preference: a population-based cohort study in Korea. Am J Clin Nutr 2010; 91:1289-93. [PMID: 20219954 DOI: 10.3945/ajcn.2009.28732] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although the incidence of gastric cancer is declining, it remains the most common cancer in Korea. There have been discrepancies in epidemiologic studies regarding a causal relation between highly salted food and the risk of gastric cancer. OBJECTIVE The aim of this study was to assess the effect of salt preference on the incidence of gastric cancer in Korean adults through a population-based, prospective cohort study. DESIGN Participants were Korean government employees, school faculty members, and their unemployed dependents, aged 30-80 y, who underwent health examinations between 1996 and 1997. In 2003, information on the gastric cancer incidence in these participants was obtained during the 6-7-y follow-up period. The final data analysis included 2,248,129 study subjects. The hazard ratio (HR) and 95% CI of the HR were estimated by using the Cox proportional hazards regression model. RESULTS The age-standardized incidence rates per 100,000 person-years for the overall total population, men only, and women only were 97.64, 136.03, and 52.90, respectively. The Cox proportional hazards regression model, with adjustment for possible confounding factors, showed evidence of an increased risk of gastric cancer with salt preference. The HRs were 1.10 (95% CI: 1.04, 1.16) and 1.10 (95% CI: 1.03, 1.17) for the overall total population and men only, respectively. CONCLUSION The current findings suggest that salt preference has a marginal positive association with a risk of gastric cancer.
Collapse
Affiliation(s)
- Jeongseon Kim
- Cancer Epidemiology Branch, Division of Cancer Epidemiology and Management, National Cancer Center Research Institute, Goyang-si, Gyeonggi-do, South Korea
| | | | | |
Collapse
|
12
|
Wang XQ, Terry PD, Yan H. Review of salt consumption and stomach cancer risk: epidemiological and biological evidence. World J Gastroenterol 2009; 15:2204-13. [PMID: 19437559 PMCID: PMC2682234 DOI: 10.3748/wjg.15.2204] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 03/23/2009] [Accepted: 03/30/2009] [Indexed: 02/06/2023] Open
Abstract
Stomach cancer is still the fourth most common cancer; thus, it remains an important public health burden worldwide, especially in developing countries. The remarkable geographic variations in the rates of stomach cancer indicate that dietary factors, including a range of food groups to which salt and/or nitrates have been added, may affect stomach cancer risk. In this paper, we review the results from ecologic, case-control and cohort studies on the relationship between salt or salted foods and stomach cancer risk. The majority of ecological studies indicated that the average salt intake in each population was closely correlated with gastric cancer mortality. Most case-control studies showed similar results, indicating a moderate to high increase in risk for the highest level of salt or salted food consumption. The overall results from cohort studies are not totally consistent, but are suggestive of a moderate direct association. Since salt intake has been correlated with Helicobacter pylori (H pylori) infection, it is possible that these two factors may synergize to promote the development of stomach cancer. Additionally, salt may also cause stomach cancer through directly damaging gastric mucus, improving temporary epithelial proliferation and the incidence of endogenous mutations, and inducing hypergastrinemia that leads to eventual parietal cell loss and progression to gastric cancer. Based on the considerable evidence from ecological, case-control and cohort studies worldwide and the mechanistic plausibility, limitation on salt and salted food consumption is a practical strategy for preventing gastric cancer.
Collapse
|
13
|
Larsson SC, Orsini N, Wolk A. Processed meat consumption and stomach cancer risk: a meta-analysis. J Natl Cancer Inst 2006; 98:1078-87. [PMID: 16882945 DOI: 10.1093/jnci/djj301] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The relationship between processed meat consumption and the risk of stomach cancer is controversial. We conducted a meta-analysis to summarize available evidence from cohort and case-control studies on this issue. METHODS We searched Medline for studies of processed meat consumption and stomach cancer published from January 1966 through March 2006. Random-effects models were used to pool the relative risks from individual studies. All statistical tests were two-sided. RESULTS Six prospective cohort studies (involving 2209 stomach cancer patients) and nine case-control studies (2495 case patients) were eligible for inclusion in the dose-response meta-analysis of processed meat consumption. The estimated summary relative risks of stomach cancer for an increase in processed meat consumption of 30 g/day, approximately half of an average serving, were 1.15 (95% confidence interval [CI] = 1.04 to 1.27) for the cohort studies and 1.38 (95% CI = 1.19 to 1.60) for the case-control studies. There was no statistically significant heterogeneity among the cohort studies (P = .42) or among the case-control studies (P = .19). In three cohort and four case-control studies that examined the association between bacon consumption and stomach cancer, the summary relative risk was 1.37 (95% CI = 1.17 to 1.61) for the highest versus lowest intake categories of bacon, without heterogeneity among these studies (P = .66). CONCLUSION Increased consumption of processed meat is associated with an increased risk of stomach cancer. However, the possibility that the association may be confounded or modified by other factors cannot be ruled out.
Collapse
Affiliation(s)
- Susanna C Larsson
- Division of Nutritional Epidemiology, The National Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77, Stockholm, Sweden.
| | | | | |
Collapse
|
14
|
Larsson SC, Bergkvist L, Wolk A. Processed meat consumption, dietary nitrosamines and stomach cancer risk in a cohort of Swedish women. Int J Cancer 2006; 119:915-9. [PMID: 16550597 DOI: 10.1002/ijc.21925] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Processed meat consumption has been associated with an increased risk of stomach cancer in some epidemiological studies (mainly case-control). Nitrosamines may be responsible for this association, but few studies have directly examined nitrosamine intake in relation to stomach cancer risk. We prospectively investigated the associations between intakes of processed meat, other meats and N-nitrosodimethylamine (the most frequently occurring nitrosamine in foods) with risk of stomach cancer among 61,433 women who were enrolled in the population-based Swedish Mammography Cohort. Information on diet was collected at baseline (between 1987 and 1990) and updated in 1997. During 18 years of follow-up, 156 incident cases of stomach cancer were ascertained. High consumption of processed meat, but not of other meats (i.e., red meat, fish and poultry), was associated with a statistically significant increased risk of stomach cancer. After adjustment for potential confounders, the hazard ratios for the highest compared with the lowest category of intake were 1.66 (95% CI = 1.13-2.45) for all processed meats, 1.55 (95% CI = 1.00-2.41) for bacon or side pork, 1.50 (95% CI = 0.93-2.41) for sausage or hotdogs and 1.48 (95% CI= 0.99-2.22) for ham or salami. Stomach cancer risk was 2-fold higher among women in the top quintile of N-nitrosodimethylamine intake when compared with those in the bottom quintile (hazard ratio = 1.96; 95% CI = 1.08-3.58). Our findings suggest that high consumption of processed meat may increase the risk of stomach cancer. Dietary nitrosamines might be responsible for the positive association.
Collapse
Affiliation(s)
- Susanna C Larsson
- Division of Nutritional Epidemiology, The National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | | | | |
Collapse
|
15
|
Wallace RA, Schluter PJ, Duff M, Ouellette-Kuntz H, Webb PM, Scheepers M. A Review of the Risk Factors for, Consequences, Diagnosis, and Management of Helicobacter pylori in Adults with Intellectual Disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2004. [DOI: 10.1111/j.1741-1130.2004.04029.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
16
|
Kim MK, Sasaki S, Sasazuki S, Tsugane S. Prospective study of three major dietary patterns and risk of gastric cancer in Japan. Int J Cancer 2004; 110:435-42. [PMID: 15095311 DOI: 10.1002/ijc.20132] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Dietary pattern analysis is an alternative and complementary approach to identify the relationship between diet and the risk of chronic disease. This study was aimed at investigating the associations between dietary patterns and the risk of gastric cancer in Japan. Using baseline data from a prospective study of 20,300 men and 21,812 women, we conducted factor analysis and identified 3 major dietary patterns, healthy, traditional and Western, and calculated the factor scores of each pattern for individuals. During 10 years of follow-up, 400 cases of gastric cancer were identified. We found an inverse association between the healthy pattern and gastric cancer risk in women [rate ratio for highest quartile (RR) = 0.56; 95% CI = 0.32-0.96; p for trend = 0.03], but not in men. In contrast, the traditional pattern was significantly associated with the increased risk of gastric cancer in both genders (for men, RR = 2.88, 95% CI = 1.76-4.72; for women, RR = 2.40, 95% CI = 1.32-4.35). The Western pattern was not associated with risk. These associations persisted in histologic subtypes. Our findings support the idea that the healthy pattern decreased the risk of gastric cancer among females, while the traditional pattern increased the risk in both genders.
Collapse
Affiliation(s)
- Mi Kyung Kim
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | | | | | | |
Collapse
|
17
|
Lissowska J, Gail MH, Pee D, Groves FD, Sobin LH, Nasierowska-Guttmejer A, Sygnowska E, Zatonski W, Blot WJ, Chow WH. Diet and Stomach Cancer Risk in Warsaw, Poland. Nutr Cancer 2004; 48:149-59. [PMID: 15231449 DOI: 10.1207/s15327914nc4802_4] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Some of the world's highest rates of stomach cancer are found in Poland. Reasons for the increased incidence are not known, but high intake of sausages and other preserved foods and low intake of fresh fruits and vegetables may be involved. A case-control study comprising residents newly diagnosed with stomach cancer during 1994-96 and controls randomly selected from the general population was conducted in Warsaw, Poland. Standardized interviews were conducted to ascertain usual consumption of 118 common foods and beverages and other exposures. Using data from direct interviews with 274 cases and 463 controls, odds ratios of stomach cancer were calculated as estimates of risks associated with dietary factors, adjusting for age, sex, education, smoking, and caloric intake. Risk of stomach cancer was inversely related to intake of total fruits and dark green-yellow vegetables and to indices of vitamins C and E and alpha- and beta-carotenes. However, risk was not significantly increased among those with high intake of pickled/salted vegetables and sausages. Risks were positively associated with increased intake of breads/cereals/rice/pasta and other refined grains, as well as a high carbohydrate index. Our findings add to the evidence of a protective effect of fruits and certain vegetables on stomach cancer risk, but do not indicate that high intake of sausage and other preserved foods typical in the Polish diet has contributed to the country's elevated stomach cancer incidence. Our data also suggest that high carbohydrate consumption may influence risk, but further confirmation is needed.
Collapse
Affiliation(s)
- Jolanta Lissowska
- Division of Cancer Epidemiology and Prevention, Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Sipetić S, Tomić-Kundaković S, Vlajinac H, Janković S, Marinković J, Maksimović J. [Diet and gastric cancer]. VOJNOSANIT PREGL 2004; 60:697-705. [PMID: 14737890 DOI: 10.2298/vsp0306697s] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this case-control study, conducted in Serbia during the period 1998-2000, was to investigate whether diet was associated with the development of gastric cancer. The case group consisted of 131 patients with histologically confirmed gastric cancer, and the control group of 131 patients with orthopedics diseases and injuries. Cases and controls were individually matched by age (+/- 2 years), gender, and place of residence. On the basis of multivariate logistic regression analysis, following factors were found as independent risk factors for gastric cancer: more frequent consumption of high-fat milk [Odds ratio (OR) = 1.45, 95% confidence interval (CI) = 0.99-2.16]; mutton, lamb and/or calf meat (OR = 2.46, 95% CI = 1.11-5.47), sugar (OR = 2.13, 95% CI = 1.43-3.18), semi-white bread (OR = 2.09, 95% CI = 1.25-3.50), and salting food (OR = 5.72, 95% CI = 2.63-12.42). Factors found as protective were: more frequent consumption of margarine (OR = 0.41, 95% CI = 0.25-0.69), "other" cheeses (OR = 0.47, 95% CI = 0.29-0.77), and fish (OR = 0.39, 95% CI = 0.19-0.76).
Collapse
Affiliation(s)
- Sandra Sipetić
- Medicinski fakultet, Institut za epidemiologiju, Beograd.
| | | | | | | | | | | |
Collapse
|
19
|
Ngoan LT, Mizoue T, Fujino Y, Tokui N, Yoshimura T. Dietary factors and stomach cancer mortality. Br J Cancer 2002; 87:37-42. [PMID: 12085253 PMCID: PMC2364286 DOI: 10.1038/sj.bjc.6600415] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2001] [Revised: 03/20/2002] [Accepted: 04/10/2002] [Indexed: 12/17/2022] Open
Abstract
The present study examined the relationship between stomach cancer and the low intake of fresh fruit and vegetables and/or a high intake of pickled, preserved or salted foods and frequent use of cooking oil. During 139,390 person-year of follow-up of over 13,000 subjects, 116 died from stomach cancer. Using a Cox proportional hazards-regression analysis of relative risk (RR, 95% CI) controlling for age, sex, smoking and other dietary factors, a significant decline was found with a high consumption of green and yellow vegetables (RR=0.4, 95% CI=0.2-0.9). Reductions of between 40 and 50% were also observed with a high consumption of fresh foods (fruit, cuttle fish, tofu, and potatoes), but these associations were not statistically significant. The risk was significantly increased by the high consumption of processed meat (RR=2.7, 95% CI=1.0-7.4) and by the frequent use of cooking oil (RR=4.0, 95% CI=1.3-11.8). The high consumption of pickled food and traditional soups also increased risk, but not significantly. The findings suggest that a diet high in salt and low in vitamins may be associated with an increase in stomach cancer.
Collapse
Affiliation(s)
- L T Ngoan
- Department of Clinical Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
| | | | | | | | | |
Collapse
|
20
|
|
21
|
Abstract
Tobacco and alcohol use are strong risk factors for cancer of the upper gastrointestinal tract. Saturated fat and red meat intake also appear to increase the risk of colorectal cancer. The strongest and most consistent dietary protective factors for gastrointestinal cancer are vegetables and fruits. Some micronutrients show beneficial effects, but the degree of protection is less than that observed from whole plant foods. Substantial decreases in the morbidity and mortality from gastrointestinal cancer could occur with more widespread adoption of dietary guidelines designed for cancer prevention.
Collapse
Affiliation(s)
- D D Hensrud
- Division of Preventive Medicine, Mayo Medical School, Rochester, Minnesota, USA
| | | |
Collapse
|
22
|
Tatsuta M, Iishi H, Baba M, Uehara H, Nakaizumi A, Iseki K. Reduction in NaCl-enhanced gastric carcinogenesis in rats fed a high-protein diet. Cancer Lett 1997; 116:247-52. [PMID: 9215870 DOI: 10.1016/s0304-3835(97)00197-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The effect of a purified, high protein diet on enhanced gastric carcinogenesis induced by oral administration of NaCl was investigated in Wistar rats. Rats were fed on a purified diet with an equalized caloric content, containing 8% NaCl and 25% casein (normal protein diet), or 50% casein (high protein diet) after oral treatment with N-methyl-N'-nitro-N-nitrosoguanidine for 25 weeks. In week 52, oral administration of NaCl had significantly increased the incidence and size of gastric cancer in rats fed a normal protein diet. However, NaCl had no significant effect on gastric carcinogenesis in rats fed a high protein diet. Oral administration of NaCl also caused a significant increase in tissue norepinephrine concentrations in the antral portion of the gastric wall, and increased the labeling indices of the antral epithelial cells of rats fed on a normal protein diet. However, in rats fed a high protein diet, administration of NaCl had no significant influence on these two parameters. These findings indicate that a high protein diet attenuates enhanced gastric carcinogenesis induced by the administration of NaCl, and that this effect may be related to its ability to decrease norepinephrine concentrations in the gastric wall, which subsequently decreases the proliferation of antral epithelial cells.
Collapse
Affiliation(s)
- M Tatsuta
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Japan
| | | | | | | | | | | |
Collapse
|
23
|
Cohen AJ, Roe FJ. Evaluation of the aetiological role of dietary salt exposure in gastric and other cancers in humans. Food Chem Toxicol 1997; 35:271-93. [PMID: 9146740 DOI: 10.1016/s0278-6915(96)00114-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The findings in laboratory and epidemiological studies relevant to the assessment of salt for carcinogenic potential are reviewed. Associations between the high consumption of certain highly salted foodstuffs, particularly in some oriental countries, and increased risk of cancer of the stomach do not incriminate salt per se. Some highly spiced foods contain potent genotoxic carcinogens, irrespective of whether they also contain salt. There is evidence in laboratory animals that high concentrations of salt may increase the incidence of gastric cancer caused by such carcinogens. This may well be attributable to a marked and sustained regenerative response in the gastric mucosa of laboratory animals chronically exposed to the cytotoxicity of hyperosmolar concentrations of salt, such a mitogenic response favouring the progression towards neoplasia. However, there is no laboratory evidence whatsoever to indicate that salt per se is a carcinogen for any site in the body; neither is there any reliable epidemiological evidence to indicate that dietary salt affects the incidence of gastric or other cancers. A particular problem in the interpretation of epidemiological studies is that the consumption of diets containing highly salted, spicy foods is often associated with low intakes of fruit and green vegetables, which contain cancer-protective antioxidants. In Western countries the incidence of cancer of the stomach has been falling for some 50 years. The consensus view is that this fall is attributable to improved food hygiene and increasingly available facilities for refrigeration. There are no grounds for supposing that the fall is attributable to a decreasing intake of salt. A high dietary salt intake does not necessarily entail exposure to salt in concentrations high enough to damage the gastric mucosa. The typical Western diet would not be expected to provide such high salt concentrations. It is concluded that there are no grounds for believing that a reduction in the average daily salt intake in the Western diet would have any effect on the risk of developing any form of cancer.
Collapse
Affiliation(s)
- A J Cohen
- Toxicology Advisory Services, Sutton, Surrey, UK
| | | |
Collapse
|
24
|
Abstract
Epidemiologic evidence on the relation between nutrition and stomach cancer is reviewed. Stomach cancer shows a distinct international variation and dramatic worldwide decline. These descriptive features suggest that dietary factors are important in determining the risk of stomach cancer. The authors assessed relevant data regarding specific dietary hypotheses in the etiology of stomach cancer. A negative association with fresh vegetables and fruits is highly consistent in numerous case-control studies in different populations. Both epidemiologic and experimental data suggest that vitamins C and carotenoids lower risk of stomach cancer. Evidence is sparse and inconsistent as to protective effects of vitamin E and selenium. Epidemiologic studies have not lent, and will not provide, supportive evidence for an etiologic role of nitrate intake. High salt intake has been associated with an increased risk in many case-control studies and limited cohort studies. Taken together with animal data, it is considered that high salt intake is a risk factor for stomach cancer. Both epidemiologic and experimental data are inconclusive as to whether high-starch diets confer an increased risk. Cohort studies using quantitative dietary assessment and biologic measurement of micronutrients are needed for further understanding of etiologic roles of dietary factors in the causation of stomach cancer.
Collapse
Affiliation(s)
- S Kono
- Department of Public Health, National Defense Medical College, Tokorozawa, Japan
| | | |
Collapse
|